The evolution of mobile technology in the NHS

As mHealth evolves and the sector adapts to its benefits, there are a number of ways that it could help address and alleviate the pressures the NHS is currently finding so difficult to deal with. Health Business’ Ben Plummer explores the possibilities.

The integration of mobile technologies into the NHS has been slower than the way it has been adopted by the broader public. However, as was found in a 2015 study, 98.9 per cent of doctors and 95.1 per cent of nurses own a smartphone, while 73.5 per cent and 64.7 per cent owned a tablet device. Additionally, 92.6 per cent of the doctors and 53.2 per cent of nurses found their smartphone to be ‘very useful’ or ‘useful’ in helping them to perform their clinical duties, all of which indicates that ‘mHealth’ now has a broader role to play in the healthcare sector.

This is also true for the other side of the mHealth coin; the increasing role of the patient in their own care, via booking remote appointments with GPs, usage of health and wellness apps that promote healthy living, portable diagnostic tools, and online therapeutic communities – all of which indirectly benefit the NHS by bringing healthcare closer to home.

As mHealth evolves and the sector adapts to its benefits, there are myriad ways that it could help address and alleviate the pressures the NHS is currently finding so difficult to deal with.

Wearables, Apps, Prevention & Management
The prevalence of mobile technologies in the NHS has led to the rise of mobile-ready software that allows nurses and doctors to monitor difficult patient conditions through a smartphone or tablet.

This effectively makes diagnostics and sources of shared intelligence portable, and helps communalise important data, making it accessible to those administering care within large and disparate hospital environments. This kind of access is particularly beneficial during peak A&E times, and at night when there are fewer staff on duty.

Major rollouts of systems that are compatible with mobile devices have become more common in recent times. Late in 2015, South Tyneside NHS Trust made public its plans to achieve the national target of becoming solely digital by 2020 with a specific push to encourage its staff to work in a ‘mobile way’. On top of this, North Middlesex NHS Trust, with a more ambitious target of total digitisation by 2017, have undertaken an initiative to scan one million documents, formatted identically as the original paper record, into its in-house central portal, which has been live and accessible to staff through mobile means for five years already. Outside of the hospital, mHealth has also had a noticeable effect. In January last year, NHS England medical director Professor Bruce Keogh made the bold prediction that wearable technology could play a ‘crucial’ part in the future of diagnostics in the NHS, saying that it ‘enables you to predict things, to act early and to prevent unnecessary admissions, thereby not only taking a load off the NHS but, more importantly, actually keeping somebody safe and feeling good’.

In an effort to ‘stop patients from reaching crisis point and being admitted to hospital or visiting their GP’, Guy’s & St. Thomas’ NHS Trust earlier this year gave 25 heart failure patients a ‘kit’ comprised of scales, a blood pressure cuff and a portable blood oxygen measurer that connects to a smartphone and transmits the results to the physician.

The overarching goal of the trial was to not only help the nurses monitoring the patient in predicting potential warning signs, but also to encourage the patient to be aware of their lifestyle and how it could potentially worsen their condition.

Fitness tracker manufacturers such as Fitbit, Jawbone, and Misfit all offer products that work in conjunction with smartphones to record general activity and exercise throughout the day, as well as sleeping patterns.

While this data is rudimentary and of little use in clinical terms, it provides the user with goals and targets that help improve on or maintain a healthy lifestyle, which in turn serves to help prevent health issues such as obesity before they need to be cured, or require NHS treatment.

According to The King’s Fund, there are about 15 million people with long-term conditions, who account for ‘about 50 per cent of all GP appointments, 64 per cent of all outpatient appointments and over 70 per cent of all inpatient bed days’.

A prominent example is diabetes, which costs the NHS 10 per cent of its annual budget, or £1.5 million a minute.

Diabetes is another chronic condition that has benefited from the increasing capability of mobile technology, with tools now on the market that allow sufferers to record blood glucose levels and immediately input the results into their smartphone. This information can then be communicated to a care provider, who will be able to address any problems much more efficiently, while simultaneously giving the patient more control over the day to day management of their health than has ever been possible before.

It is obvious that the wearable and mobile technology arena is very much in its infancy in relation to the health sector, and there is much testing and evaluating of their benefits on a clinical level to be done before they become commonplace in the healthcare system.

But it is realistic and sensible to take these innovations as more than a novelty, and begin to think creatively and with an open mind as to how they can be strategically applied to issues that GPs, doctors, and workers on the frontline struggle to handle throughout the NHS.

Missed appointments and Care at a Distance
Missed appointments are a well documented, serious financial strain on the NHS, with missed GP appointments costing ‘in excess of £162 million a year’, and missed outpatient appointments costing the NHS as a whole £750 million a year. To combat this, a study was conducted by the Institute of Global Health Innovation at Imperial College London, the Department of Health and the Behavioural Insights Team, that found that by simply texting patients, notifying them of their appointment and the associated cost to the NHS, ‘Did Not Attend’ (DNAs) fell by almost a quarter.

This success was replicated in 2016 in Gwent, Wales, where reminding patients of appointments seven days, then again two days, in advance, as well as the cost of the appointment should it be missed, reduced DNAs by 30 per cent.

An approach like this is a positive example of how the NHS can exploit how we are now inextricably reliable on our phones as a way of planning our routines in day to day life to its advantage.

There is also now evidence of trusts exploring the potential to help patients at a distance through video appointments, in order to tackle the pressures that hospitals face in having to see patients on site where that may not be strictly necessary.

If a patient only requires a routine check up, without the apparent need for a physical examination, then it makes financial and logistical sense to offer a ‘pre examination’ to assess whether more intimate treatment may be necessary.

A successful example of this approach in practice was a pilot, ran by South West London & St. George’s NHS Trust, wherein Skype appointments were offered to patients of two departments – Sutton Community Mental Health Teams and the Deaf Community Teams – to ‘see if patients benefit from the opportunity to have an alternative way to have consultations’.

In a case study of the trial, the Trust said: “Patients did not take part if they were not comfortable with the idea or if clinicians did not think they were suitable. All initial consultations remained face‑to‑face, were only permitted on Trust devices, and had to be conducted in a quiet place where they would not be interrupted or overheard by other people. All patients who used Skype were very positive about the process, and all patients said they would definitely use it again in the future.”

Remote bookings
Another way that patients can get the medical attention they need is through remote appointment bookings via third parties. NHS approved, online GP services such as Babylon Health, Push Doctor, Zesty and Dr Now offer online consultations with medical professions for a fee, either as a subscription service or on a ‘pay per consultation’ basis. At a time where GP surgeries are struggling to deal with the weight of demand from an ageing population, this can be an attractive option for both doctors who can register to the service in order to make the most of their time between appointments – or in place of cancelled ones – and patients who have been unable to get the attention they need within a timeframe which they feel they need.

There are more advanced technologies in the same vein that will no doubt rise to significance, such as portable diagnostics and implantable smart objects.

However, as it stands, mHealth’s main, demonstrable benefits are how it brings doctors and patients closer together digitally, while removing the need to meet face to face, and its ability to place valuable data in the pocket of caregivers.

As the populations grows and ages, and budgets become ever tighter, it becomes clearer every year that both the traditional methods of treatment, and the cumbersome, paper heavy internal processes that are still prevalent in NHS institutions, face soon‑to-be insurmountable logistical problems.

It therefore makes sense both from a medical and business perspective to explore the possibilities that the mobile internet can offer, and be open to collaboration with experts in the field of mHealth to help aid its integration into the healthcare system in a similar way to how it has been embraced by the private sector.